On the costs and benefits of supported communication for aphasia training for healthcare practitioners: a pilot study of post-acute rehabilitation

G. Barton, A Clark, K Lane, I. Macrae, V. Pomeroy, D. Stanton, P. White

Research output: Contribution to conferencePaperpeer-review


People with aphasia may not fully benefit from rehabilitation for a number of reasons to do with their communication. Participation, which is key to the success of most treatments in stroke rehabilitation [1] may be adversely affected by ‘barriers’ such as inaccessible information, negative staff attitudes, or unskilled communication partners. Although experienced stroke practitioners might be expected to already possess the necessary skills to support people with aphasia, communication problems in healthcare settings do not necessarily resolve with clinical experience. Indeed, individual communication skills training may not in itself lead to improved patient outcomes if not supported by attention to the particular needs of the practice setting and strategies for sustained implementation of the intervention [2].
We report findings from an ongoing pilot study, which aims to build on existing evidence for the use of supported communication training for service providers [3,4], investigating whether the techniques can be learned by staff, and used during everyday rehabilitation to enhance participation and improve outcomes for people with aphasia. In particular we investigate: adaptation of the intervention to the context; application and acceptability of the intervention to staff and patients; evidence for clinical efficacy; cost-effectiveness of providing supported communication compared to standard practice.
An exploratory cluster controlled assessor blinded trial (supported communication enhanced care vs routine care) and cost-effectiveness analysis.
Focus group discussions with staff and aphasia experts were used to develop the intervention and evaluate its implementation. Participating intervention unit staff were asked to complete a monthly ‘learning log’ reflecting on the process and impact of implementing supported communication. Self-report and observational methods were used to gain the patients’ perspective in terms of: health-related quality of life and health outcomes; satisfaction with staff communication; participation in rehabilitation.
In line with UK guidance [5], we collected data on: resources associated with training regimes; input by staff in each of the stroke units; and at 6 month follow-up, any patient re-admissions to hospital, and other health or non-healthcare contacts. Appropriate unit costs were assigned to levels of resource use; the impact on health outcomes was also examined.
We recruited nurses, therapists and healthcare assistants. Practitioner and aphasia expert contributions were key to the design and delivery of classroom and experiential training. There were numerous challenges to the organisation and delivery of training impacting on efficiency. Return rate for ‘learning logs’ was 30%; staff reflected on their own confidence levels in using supported communication and the impact of aphasia severity and type on completing rehabilitation tasks. Raised awareness levels among all ward staff about communicating with PWA were attributed to the intervention. There were numerous benefits for aphasia experts involved as advisers, assessors and trainers. Challenges to patient recruitment necessitated the introduction of alternative data collection procedures; the implications for recruiting people with severe aphasia soon after stroke are discussed. We will also report on the use of EQ-5D as a measure of effectiveness for economic analysis with this population.
Feasibility data from this pragmatic evaluation of a complex intervention provides important information which can be used to inform the design of a more definitive study. Estimates of costs and benefits need to be treated with caution, due to the small sample sizes.

Funded by NIHR Research for Patient Benefit (PB-PG-0609-17264) ISRCTN: 37002304
1. The Royal College of Physicians (2008).
2. Simmons Mackie NN et al (2007) Aphasiology, 21, 1, 39-66.
3. Kagan et al (2001) Journal of Speech, Language & Hearing Research, 44, 624-638.
4. Simmons Mackie et al (2010) Archives of Physical and Medical Rehabilitation, 91, 1814-1837.
5. National Institute of Health and Clinical Excellence Guide to the Methods of Technology Appraisal (2008) NICE publications.
Environmental intervention; cost effectiveness
Original languageEnglish
Number of pages1
Publication statusPublished - 20 Jun 2014


  • Aphasia
  • communication partner training
  • feasibility study
  • HE evaluation

Cite this